Question

Chapter 72 Case Study


You are assigned to the transplant clinic at the healthcare agency where you are doing a clinical rotation. Your instructor assigns you to care for Mr. O, 30 years old, who received a heart and lung transplant 6 weeks ago. He is single with a large extended family. He tells you, “I have six nieces and nephews. The oldest is 10, and the youngest is 8 months. I was so glad to see all of them when I went home. They really cheer me up.” Mr. O is taking multiple drugs to manage his health, including glucocorticoids. Your instructor asks you to develop a plan of care for him that focuses on minimizing the adverse effects of long-term glucocorticoid therapy.


1. What do you identify as a priority piece of information to explain to Mr. O?



2. What side effects should you inform Mr. O about?

Answer 1

Glucocorticisteroid therapy comes under a class of steroid hormones. Glucocorticoid is synthesis in the adrenal cortex and it helps in gluconeogenesis,amino acid metabolism, inflammatory reactions. It is commonly used to treat diseases involves inflammation. It is usually used to treat certain autoimmune diseases like rheumatoid arthritis,ulcerative colitis,inflammatory bowel disease, post operative for patients undergone renal,heart and lung transplant,asthma,cancer,heart failure.

The prime goal is to reduce the adverse effects results from steroid therapy. The common adverse effects after long term usage of glucocorticoids includes steroid induced diabetes, cushing syndrome (occurs as a result of exposure to high levels of cortisols),steroid induced obesity,osteoporosis as prolonged intake of steroids results in softening of bones, elevated blood pressure, polycystic ovarian disease, depression,decreases sexual drive(libido),muscle weakness.

Instruct the patient to follow low salt diet or potassium rich diet as intake of more sodium in diet results in generalized edema. Encourage patient to take steroids along with food to prevent stomach upset. Ask patient to avoid alcoholic beverages as it induce gastritis. If one dose is missed ask to take immediately once remembered the dose. Don't take double dose as it may leads to complications.

Periodical monitoring of blood glucose levels and urinalysis to check for steroid induced diabetes and any deviation in renal function. Ophthalmic examination to detect and steroid induced visual disturbances. Educate the patient to avoid crowd as steroid medication decreases the patient immune response exposure to the group will increases the chances of infection.